Retention in Hypertension Care in Primary Care Settings

Globally, more than 1.2 billion individuals have hypertension, which causes more than 19 million deaths yearly due to cardiovascular disease. High clinical care retention is critical for long-term hypertension control, yet 1-year retention rates are as low as 50% in many resource-limited settings. To describe the retention rates and related determinants among hypertensive patients in primary health care clinics.

Data were gathered from persons 18 years old by trained study personnel at 60 public, basic healthcare institutions between January 2020 and July 2021 as part of the Hypertension Treatment Program. The 3-month rolling average 37-day retention rate in hypertension care was computed by dividing the number of patients who returned for a second visit 37 days after their first visit by the total number of registered hypertensive patients over multiple 3-month periods. In addition, regression models were developed to assess the relationships between patient, site, and area council-level characteristics, treatment, control status, and the 37-day retention rate.

There were 10,686 patients in all (68.2% were female, mean [SD] age=48.8 [12.7] years). The 3-month rolling average 37-day retention rate was 41% (95% CI: 37% – 46%), with substantial fluctuation. The retention rate was higher in patients who were older (adjusted OR (aOR) [95% CI]: 1.01 per year [1.007, 1.014]), female (aOR [95% CI]: 1.11 [1.002, 1.22]), had a higher BMI (aOR [95% CI]: 1.01 [1.002, 1.02]), from the area council (aOR [95% CI]: 2.29 [1.28, 4.09]), (aOR [95% CI]: 1.33 [1.20, 1.47]). Although there was diversity, retention in hypertension management was unsatisfactory in primary health care institutions. However, modifiable retention variables had been discovered and might be targeted for multilevel, contextualized implementation techniques.

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